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Tarrada A, Hingray C, Aron O, Dupont S, Maillard L, de Toffol B. Postictal psychosis, a cause of secondary affective psychosis: A clinical description study of 77 patients. Epilepsy Behav 2022; 127:108553. [PMID: 35074723 DOI: 10.1016/j.yebeh.2022.108553] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 12/28/2021] [Accepted: 01/01/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Postictal psychosis (PIP) is a severe complication occurring at least in 2% of patients with epilepsy. Since the 19th century, psychiatrists have reported the specificity of PIP presentation, but descriptions did not clearly distinguish PIP from after-seizure delirium. This study aimed to provide a precise description of psychiatric signs occurring during PIP, and improve recognition of PIP. METHODS We performed a review of clinical descriptions available in literature (48 patients), that we gathered with a retrospective multicentric case series of patients from three French epilepsy units (29 patients). For each patient, we collected retrospectively the psychiatric signs, and epilepsy features. RESULTS We found a high prevalence of persecutory (67.5%) and religious (55.8%) delusions, with almost systematic hallucinations (83.1%) and frequent mood disturbances (76.6%), especially euphoria. Severe consequences were not negligible (other-directed assault in 20.8%, self-directed in 13.0%). The type of delusion was associated with mood symptoms (p = 0.017). Episode onset was mainly sudden/rapid (90.9%), its duration was mostly between one and 14 days (64.9%) and the response to antipsychotic medication was good. Disorder was recurrent in more than a half of the sample (57.1% of patients with at least 2 episodes). CONCLUSION Considering our findings, PIP resembles more an affective psychosis, than a purely psychotic disorder. The presence of affective signs differentiates PIP from other psychotic comorbidities in epilepsy. Additionally, resemblance between PIP and psychotic manic episode might help to discuss links between epilepsy and bipolar disorder.
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Affiliation(s)
- Alexis Tarrada
- Unité de monitoring video-EEG, service de neurologie, explorations fonctionnelles, hôpital central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France; Université Paris Descartes, Faculté de Médecine, 75006 Paris, France.
| | - Coraline Hingray
- Unité de monitoring video-EEG, service de neurologie, explorations fonctionnelles, hôpital central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France; Pôle Universitaire du Grand Nancy, Centre Psychothérapique de Nancy, 54000 Laxou, France.
| | - Olivier Aron
- Unité de monitoring video-EEG, service de neurologie, explorations fonctionnelles, hôpital central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France.
| | - Sophie Dupont
- Unité d'Epileptologieet Unité de réadaptation, Hôpital de la Pitié-Salpêtrière, AP-HP, Centre de recherche de l'Institut du cerveau et de la moelle épinière (ICM), UMPC-UMR 7225 CNRS-UMRS 975 Inserm, Paris, France; Université Paris Sorbonne, Paris, France; CRHU de Nancy, Département de Neurologie, Nancy, France.
| | - Louis Maillard
- Unité de monitoring video-EEG, service de neurologie, explorations fonctionnelles, hôpital central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France; Université de Lorraine, CNRS, CRAN, UMR 7039, Nancy, France.
| | - Bertrand de Toffol
- UMR 1253, iBrain, Université de Tours, Inserm, France; Service de Neurologie & Neurophysiologie Clinique, CHU Bretonneau, Tours, France; Service de Neurologie, Centre Hospitalier de Cayenne, France; CIC INSERM, 1424 CH Cayenne, France.
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Nishida T, Usui N, Inoue Y, Takahashi Y. Psychiatric outcome of temporal lobe epilepsy surgery: A prospective, 2-year follow-up study. Epilepsy Behav 2021; 122:108216. [PMID: 34325156 DOI: 10.1016/j.yebeh.2021.108216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We performed a prospective, longitudinal, 2-year follow-up study to clarify psychiatric courses and outcomes after temporal lobe epilepsy surgery. METHODS We assessed 141 patients (68 men, 73 women) aged 16 or older with structured interviews and psychiatric rating scales before surgery and 3 months, 1 year, and 2 years afterward. RESULTS Fifty-two patients (36.9%) had a psychiatric condition before surgery or during the follow-up period or both. The number of patients with a psychiatric condition decreased from 31 (22.0%) before surgery to 14 (9.9%) at 2 years. On the basis of our results, we defined 5 courses of psychiatric conditions: course 0, no psychopathology (n = 89, 63.1%); course 1, remission or resolution of a presurgical psychiatric condition after surgery (n = 19, 13.5%); course 2, new onset, transient psychiatric condition after surgery (n = 19, 13.5%); course 3, new onset, persistent psychiatric condition after surgery (n = 2, 1.4%); and course 4, chronic psychiatric condition before and after surgery (n = 12, 8.5%). In 14/25 (56.0%) patients with a mood or anxiety disorder before surgery, the condition remitted or resolved after surgery (course 1). Eighteen of 110 patients (16.4%) without any psychopathology before surgery developed mood or anxiety disorders afterward, including major depressive disorder in 13 patients (courses 2 and 3); in more than half of these patients, the disorder manifested within 1 year. More patients with a past history of psychiatric conditions were found in course 2 than in course 0. The duration of epilepsy was longer in course 4 than in course 0, and age at epilepsy onset was lower in course 4 than in course 0. SIGNIFICANCE Most patients with a psychiatric condition show a favorable outcome 2 years after surgery; however, some show a transient worsening or new onset of psychiatric conditions, in particular depression.
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Affiliation(s)
- Takuji Nishida
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan.
| | - Naotaka Usui
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Yushi Inoue
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Yukitoshi Takahashi
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
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Kanemoto K. Psychotic Disorders in Epilepsy: Do They Differ from Primary Psychosis? Curr Top Behav Neurosci 2021; 55:183-208. [PMID: 34426945 DOI: 10.1007/7854_2021_234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Any attempt to compare the definitions of symptoms listed for "primary psychoses" with those adopted in studies of psychoses in patients with epilepsy (PWE) will encounter problems of heterogeneity within both conditions. In this manuscript, five psychotic illnesses listed in Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-5), that is, brief psychotic illness, schizophreniform disorder, schizophrenia, delusional disorder, and schizoaffective disorder are compared with postictal (or periictal) and interictal psychotic disorders in PWE. After examining definitions of primary psychoses, definitions of psychoses adopted in the papers dealing with postictal and interictal psychoses are summarized. Further, diagnostic criteria of five types of psychotic disorders in PWE proposed in 2007 by Krishnamoorthy et al. are also discussed, which include postictal psychosis, comorbid schizophrenia, iatrogenic psychosis caused by antiepileptic drugs (AEDs) (AED-induced psychotic disorder: AIPD), and forced normalization. Evidently, a comparison between postictal psychosis and schizophrenia is pointless. Likewise, schizophrenia may not be an appropriate counterpart of forced normalization and AIPD, given their acute or subacute course.Based on these preliminary examinations, three questions are selected to compare primary psychoses and psychoses in PWE: Is postictal psychosis different from a brief psychotic disorder? Does epilepsy facilitate or prevent the development of psychosis or vice versa? Is interictal psychosis of epilepsy different from process schizophrenia? In conclusion, antagonism between psychosis and epileptic seizures in a later stage of active epilepsy seems not to be realized without reorganization of the nervous system promoted during an earlier stage. Both genetic predisposition and the summated effects of epileptic activity must be taken into consideration as part of a trial to explain interictal psychosis. Interictal psychosis is an aggregate of miscellaneous disorders, that is, co-morbid schizophrenia, AED-induced psychotic disorders, forced normalization, and "epileptic" interictal psychosis. Data are lacking to conclude whether differences exist between process schizophrenia and "epileptic" interictal psychosis in terms of negative symptoms, specific personal traits, and the "bizarre-ness" of delusory-hallucinatory contents. These discussions may shed light on the essence of process schizophrenia, thus allowing it stand out and receive increased focus.
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Emotion and mood disorders associated with epilepsy. HANDBOOK OF CLINICAL NEUROLOGY 2021; 183:169-173. [PMID: 34389116 DOI: 10.1016/b978-0-12-822290-4.00008-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Epilepsy is a disorder characterized by recurrent seizures. Epilepsy can alter mood and emotions. Treatments for epilepsy can also alter mood and emotions. This chapter reviews the emotional changes that can occur before, during, and after a seizure, such as fear and anger, the interictal mood disorders associated with epilepsy, such as depression and anxiety, as well as alterations of emotional processing including comprehending and expressing emotional prosody and faces. The possible treatments of these emotional and mood disorders are also reviewed.
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Ngo VTH, Camacho H, Singh J. You Are The One Who Was Beating Me": A Case Report of a Patient with Postictal Psychosis Secondary to Bilateral Temporal Lobe Epilepsy. Cureus 2019; 11:e6069. [PMID: 31827998 PMCID: PMC6890155 DOI: 10.7759/cureus.6069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Postictal psychosis is a rare but potentially serious complication in patients with seizure disorders. There is no consensus on best practices in managing and treating postictal psychosis as well as other psychoses of epilepsy, but current research is investigating topics such as adherence to seizure medications and antipsychotic administration during or before psychosis and addressing psychosocial stressors as potential components of effective treatment. We present a case report detailing a patient’s lengthy history of postictal psychosis due to her underlying temporal lobe epilepsy; her disease course as correlated by a diagnostic electroencephalogram (EEG), her history of medication nonadherence, and the treatment of postictal psychosis are also discussed.
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Affiliation(s)
- Vincent Trung H Ngo
- Department of Psychiatry, UCLA-Kern, Ross University School of Medicine, Bakersfield, USA
| | - Homero Camacho
- Department of Psychiatry, UCLA-Kern, Kern Medical, Bakersfield, USA
| | - Jasbir Singh
- Department of Psychiatry, UCLA-Kern, Kern Medical, Bakersfield, USA
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Hamed SA, Attiah FA. Psychosis in adults with epilepsy and its relationship to demographic, clinical and treatment variables. Neurol Res 2019; 41:959-966. [PMID: 31280704 DOI: 10.1080/01616412.2019.1638017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objectives: Psychiatric symptoms and disorders are commonly reported with epilepsy. This study aimed to determine the prevalence of interictal psychosis (IIP) in adults with epilepsy and its risk predictors. Methods: The study included 710 patients (mean age: 36.40 years; age at onset: 13.58 years; duration of epilepsy: 22.80 years). All underwent neurological and psychiatric interviewing, electroencephalography and brain imaging. Results: IIP was reported in 20.65%, of them 50% had temporal lobe epilepsy with impaired awareness and/or to bilateral tonic clonic, 42.47% had frontal lobe epilepsy with impaired awareness and/or to bilateral tonic clonic and 7.53% had generalized tonic-clonic seizures. Compared to patients without psychosis, patients with psychosis were older at age of examination, had earlier age at onset, frequent seizures, longer duration of epilepsy and long-term antiepileptic drugs therapy and many relatives with epilepsy. Nearly 76.71% had history of postictal psychosis (PIP). The mean age of onset of IIP was 30.45 years and its mean duration was 3.84 months. Approximately 22% of patients with IIP had family history of psychosis. Patients developed IIP 10 years or more after epilepsy onset. Multivariate logistic regression analyses showed that predictors for IIP were the age at onset and duration of epilepsy, number of seizures, family history of epilepsy or psychosis, history of PIP and different types of epilepsy. Conclusion: IIP is not infrequent with chronic epilepsy regardless to its type. These findings emphasize the importance of optimizing patients' treatment and early recognition and management of IIP. Abbreviations: IIP: interictal psychosis; PIP: post-ictal psychosis; TLE: temporal lobe epilepsy; FLE: frontal lobe epilepsy; GTC: generalized tonic clonic; AEDs: antiepileptic drugs; CBZ: carbamazepine; VPA: valproate; LEV: levetiracetam; APDs: antipsychotic drugs.
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Affiliation(s)
- Sherifa Ahmed Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital , Assiut , Egypt
| | - Fadia Ahmed Attiah
- Department of Neurology and Psychiatry, Assiut University Hospital , Assiut , Egypt
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Dobesberger J, Höfler J, Leitinger M, Kuchukhidze G, Zimmermann G, Thomschewski A, Unterberger I, Walser G, Kalss G, Rohracher A, Neuray C, Kobulashvili T, Höller Y, Trinka E. Personalized safety measures reduce the adverse event rate of long-term video EEG. Epilepsia Open 2018; 2:400-414. [PMID: 29588971 PMCID: PMC5862109 DOI: 10.1002/epi4.12078] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2017] [Indexed: 11/07/2022] Open
Abstract
Objective Safety in epilepsy monitoring units (EMUs) has become an increasing concern because adverse events occur in up to 10% of patients undergoing long‐term video EEG in EMUs. The aim of this study was to assess the effectiveness of a specific safety protocol in an EMU. Methods We retrospectively assessed the adverse event rates in a group without (group 1, 84‐month period, Innsbruck, Austria) and a group with (group 2, 33‐month period, Salzburg, Austria) personalized safety measures utilizing a standardized protocol for long‐term epilepsy monitoring in high‐risk patients. Differences in adverse event rates during and after long‐term video EEG between the two groups were calculated and compared. Results In group 1, 44/507 (9%, 95% confidence interval [CI] 6.5–11.5%) patients experienced 53 adverse events: 20/507 (4%, 95% CI 2.6–6.0%) patients had psychiatric events, 15/507 (3%, 95% CI 1.8–4.8%) patients sustained a total of 19 injuries during seizures, and 10/507 (2%, 95% CI 1.1–3.6%) patients had 13 episodes of status epilepticus; one adverse event was treatment‐related (valproic acid–induced encephalopathy; 1/507, 0.2%, 95% CI 0.0–1.1%). By using the new safety protocol in group 2, the adverse event rate was only 5% (95% CI 3.4–7.6%; 30 adverse events in 26/491; 45% reduction; p = 0.036), in contrast. These events included 13 psychiatric complications in 13/491 (2%, 95% CI 1.6–4.5%, p = 0.252) patients, 12 seizure‐related injuries in 9/491 (2%, 95% CI 1.0–3.4%, p = 0.250) patients, and 5 episodes of status epilepticus in 4/491 (1%, 95% CI 0.3–2.1%, p = 0.120) patients. Significance Implementation of personalized safety measures in high‐risk patients resulted in a clinically relevant reduction of adverse events in the EMU. Safety protocols are a valid tool to reduce the occurrence of adverse events in EMUs.
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Affiliation(s)
- Judith Dobesberger
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - Julia Höfler
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - Markus Leitinger
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - Giorgi Kuchukhidze
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria.,Department of Neurology Medical Innsbruck University Innsbruck Austria
| | - Georg Zimmermann
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - Aljoscha Thomschewski
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria.,Department of Mathematics Paris Lodron University Salzburg Austria.,Spinal Cord Injury and Tissue Regeneration Center Paracelsus Medical University Salzburg Austria
| | - Iris Unterberger
- Department of Neurology Medical Innsbruck University Innsbruck Austria
| | - Gerald Walser
- Department of Neurology Medical Innsbruck University Innsbruck Austria
| | - Gudrun Kalss
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - Alexandra Rohracher
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - Caroline Neuray
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - Teia Kobulashvili
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - Yvonne Höller
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - Eugen Trinka
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
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Leung LS, Jin M, Chu L, Ma J. Positive allosteric modulator of GABAB receptor alters behavioral effects but not afterdischarge progression induced by partial hippocampal kindling. Neuropharmacology 2016; 110:154-164. [DOI: 10.1016/j.neuropharm.2016.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 06/17/2016] [Accepted: 07/15/2016] [Indexed: 12/22/2022]
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Clinique et neurobiologie des psychoses post-ictales. Encephale 2016; 42:443-447. [DOI: 10.1016/j.encep.2015.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/09/2015] [Accepted: 12/14/2015] [Indexed: 11/18/2022]
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Abstract
Psychosis of epilepsy (POE) is a term applied to a group of psychotic disorders with a distinct phenomenology in which potential etiopathogenic mechanisms are believed to be closely related to a seizure disorder. POE can present as interictal psychotic episodes, which may often differ semiologically from primary schizophrenic disorder. They may present as ictal or postictal psychotic episodes and may be the expression of an iatrogenic process to pharmacologic and/or surgical interventions.Epilepsy and POE have a complex and bidirectional relation, as not only are patients with epilepsy at greater risk of developing a psychotic disorder, but patients with a primary psychotic disorder are also at greater risk of developing epilepsy. The prevalence of POE is more than 7 times higher than the frequency of primary schizophreniform disorders in the general population. While POE has been associated with focal epilepsy of temporal and frontal lobe origin, its etiology and pathophysiology of POE have yet to be established.The treatment of all forms of POE, with the exception of ictal psychotic episodes, requires the use of antipsychotic drugs, preferably the atypical antipsychotic agents with a very low or negligible potential to lower the seizure threshold (eg, risperidone, apiprazole), starting at a low dose with stepwise increments.
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de Toffol B. "Le grand mal intellectuel" by Jules Falret (1861), the first complete description of postictal psychosis. Epilepsy Behav 2016; 54:128-30. [PMID: 26708061 DOI: 10.1016/j.yebeh.2015.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 11/19/2015] [Accepted: 11/21/2015] [Indexed: 10/22/2022]
Abstract
This paper presents the first complete description of postictal psychosis, made by the French psychiatrist Jules Falret. This description, written in 1861, was the first to fulfill modern diagnostic criteria. We will examine why this syndrome, well defined in the 19th century, was forgotten for over a century.
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Affiliation(s)
- Bertrand de Toffol
- Service de Neurologie & Neurophysiologie Clinique, INSERM U930, CHU Bretonneau, Tours, France.
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Abstract
BACKGROUND This is an updated version of the original Cochrane review published in Issue 4, 2008.People suffering from epilepsy have an increased risk of experiencing psychotic symptoms. The psychotic syndromes associated with epilepsy have generally been classified as ictal, postictal, and interictal psychosis. Anticonvulsant drugs have been reported to precipitate psychosis. Moreover, all antipsychotic drugs have the propensity to cause paroxysmal electroencephalogram abnormalities and induce seizures. OBJECTIVES To evaluate the benefits of interventions used to treat clinically significant psychotic symptoms occurring in people with epilepsy with regard to global improvement, changes in mental state, hospitalization, behavior, quality of life, effect on the frequency of seizures, and interaction with antiepileptic drugs. SEARCH METHODS We searched the Cochrane Epilepsy Group's Specialized Register (23 March 2015), the Cochrane Central Register of Controlled Trials (CENTRAL via the Cochrane Register of Studies Online (CRSO), 23 March 2015), MEDLINE (Ovid, 1946 to 23 March 2015), PsycINFO (1887 to 23 March 2015), CINAHL (1937 to 23 March 2015), and BIOSIS Previews (1969 to 23 March 2015).Two review authors (SF and AS) independently inspected the citations identified from the search. We identified potentially relevant abstracts and assessed full papers for inclusion and methodological quality. SELECTION CRITERIA All randomized controlled trials comparing drugs, behavior therapy, cognitive behavior therapy, or other non-pharmacological interventions used to relieve psychotic symptoms in people with epilepsy. DATA COLLECTION AND ANALYSIS We planned to extract and analyze the data from all relevant studies using standardized methods. As only one study met the inclusion criteria, we attempted no meta-analysis. MAIN RESULTS After independently assessing the abstracts and titles of 618 articles, we selected five relevant abstracts. Ultimately we found only one study meeting the inclusion criteria, which was available only as an abstract. This study compared the use of olanzapine (10 mg/day) with haloperidol (12 mg/day) in 16 people suffering from schizophrenia-like psychosis of epilepsy. Thirteen participants completed the study. Significant improvement was associated with use of olanzapine. We did not identify any study on psychosocial interventions in people suffering from epilepsy and psychosis. AUTHORS' CONCLUSIONS We found only one randomized controlled trial, which lacked the power to test the efficacy of antipsychotics in those suffering from psychosis concomitant with epilepsy.Limited evidence from this small randomized controlled trial suggests an improvement in psychotic symptoms, but not other outcome measures, with the use of an antipsychotic. The effects on seizure control are not well studied. Further trials are required to inform practice.
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Affiliation(s)
- Saeed Farooq
- Keele UniversityResearch Institute for Primary Care and Health SciencesStaffordshireUKST5 5BG
| | - Akhtar Sherin
- Kohat University of Science and Technology (KUST)KUST Institute of Medical SciencesKohatPakistan
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Yasumoto S, Motooka H, Ito Y, Uchimura N. A change in electrographic activity and blood flow during interictal and postictal psychotic states in a patient with epilepsy. EPILEPSY & BEHAVIOR CASE REPORTS 2015; 4:13-9. [PMID: 26106577 PMCID: PMC4475786 DOI: 10.1016/j.ebcr.2015.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 02/21/2015] [Accepted: 02/25/2015] [Indexed: 11/09/2022]
Abstract
We report a patient with epilepsy who experienced interictal and postictal psychoses. Her psychiatric symptoms consisted of grandiose and fantastic delusions during both psychotic states. During remission, electroencephalography showed bitemporal epileptiform discharges that were predominant in the right temporal region. Epileptiform discharges present during the psychotic states were predominant in the left temporal region. Single-photon emission computed tomography showed hyperperfusion in the left basal ganglia during the interictal psychotic state and hyperperfusion in the right temporal lobe and left basal ganglia during the postictal psychotic state. We suggest that the occurrence of postictal and interictal psychotic states in this patient were associated with a common change in electrographic activity and blood flow.
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Affiliation(s)
- Shingo Yasumoto
- Department of Neuropsychiatry, The University of Kurume Hospital, Japan
| | - Hiromichi Motooka
- Department of Neuropsychiatry, The University of Kurume Hospital, Japan
| | - Yuji Ito
- Department of Neuropsychiatry, The University of Kurume Hospital, Japan
| | - Naohisa Uchimura
- Department of Neuropsychiatry, The University of Kurume Hospital, Japan
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Rubboli G, Beniczky S, Claus S, Canevini MP, Kahane P, Stefan H, van Emde Boas W, Velis D, Reus E, Gil-Nagel A, Steinhoff BJ, Trinka E, Ryvlin P. A European survey on current practices in epilepsy monitoring units and implications for patients' safety. Epilepsy Behav 2015; 44:179-84. [PMID: 25725329 DOI: 10.1016/j.yebeh.2015.02.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 02/01/2015] [Accepted: 02/04/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to survey current practices in European epilepsy monitoring units (EMUs) with emphasis on safety issues. METHODS A 37-item questionnaire investigating characteristics and organization of EMUs, including measures for prevention and management of seizure-related serious adverse events (SAEs), was distributed to all identified European EMUs plus one located in Israel (N=150). RESULTS Forty-eight (32%) EMUs, located in 18 countries, completed the questionnaire. Epilepsy monitoring unit beds are 1-2 in 43%, 3-4 in 34%, and 5-6 in 19% of EMUs; staff physicians are 1-2 in 32%, 3-4 in 34%, and 5-6 in 19% of EMUs. Personnel operating in EMUs include epileptologists (in 69% of EMUs), clinical neurophysiologists trained in epilepsy (in 46% of EMUs), child neurologists (in 35% of EMUs), neurology and clinical neurophysiology residents (in 46% and in 8% of EMUs, respectively), and neurologists not trained in epilepsy (in 27% of EMUs). In 20% of EMUs, patients' observation is only intermittent or during the daytime and primarily carried out by neurophysiology technicians and/or nurses (in 71% of EMUs) or by patients' relatives (in 40% of EMUs). Automatic detection systems for seizures are used in 15%, for body movements in 8%, for oxygen desaturation in 33%, and for ECG abnormalities in 17% of EMUs. Protocols for management of acute seizures are lacking in 27%, of status epilepticus in 21%, and of postictal psychoses in 87% of EMUs. Injury prevention consists of bed protections in 96% of EMUs, whereas antisuffocation pillows are employed in 21%, and environmental protections in monitoring rooms and in bathrooms are implemented in 38% and in 25% of EMUs, respectively. The most common SAEs were status epilepticus reported by 79%, injuries by 73%, and postictal psychoses by 67% of EMUs. CONCLUSIONS All EMUs have faced different types of SAEs. Wide variation in practice patterns and lack of protocols and of precautions to ensure patients' safety might promote the occurrence and severity of SAEs. Our findings highlight the need for standardized and shared protocols for an effective and safe management of patients in EMUs.
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Affiliation(s)
- Guido Rubboli
- Danish Epilepsy Center, Filadelfia/University of Copenhagen, Kolonivej 1, 4293 Dianalund, Denmark; IRCCS Institute of Neurological Sciences, Bellaria Hospital, via Altura 3, 40139 Bologna, Italy.
| | - Sandor Beniczky
- Neurophysiology Department, Danish Epilepsy Center, Visbys Alle' 5, 4293 Dianalund, Denmark; Department of Neurophysiology, Aarhus University, Norrebrogade 44, 8000 Aarhus.
| | - Steven Claus
- Department of Clinical Neurophysiology, SEIN - Epilepsy Institute in The Netherlands, Meer en Bosch, The Netherlands; Department of CNP at the Free University Medical Center, Achterweg 5/P.O. Box 540 2103 SW Heemstede/2130 AM Hoofddorp, The Netherlands; Department of Neurosurgery at the Free University Medical Center, Achterweg 5/P.O. Box 540 2103 SW Heemstede/2130 AM Hoofddorp, The Netherlands.
| | - Maria Paola Canevini
- Epilepsy Unit, San Paolo Hospital, Department of Health Sciences, University of Milan, Via Antonio di Rudinì, 8, 20142 Milan, Italy.
| | - Philippe Kahane
- INSERM U836, Univ. Grenoble Alpes, GIN, and Epilepsy Unit, Michallon Hospital, Boulevard de la Chantourne BP 217, 38043 Grenoble Cedex 9, France.
| | - Hermann Stefan
- Epilepsy Center Erlangen (ZEE), University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Walter van Emde Boas
- Department of Clinical Neurophysiology, SEIN - Epilepsy Institute in The Netherlands, Meer en Bosch, The Netherlands; Department of CNP at the Free University Medical Center, Achterweg 5/P.O. Box 540 2103 SW Heemstede/2130 AM Hoofddorp, The Netherlands; Department of Neurosurgery at the Free University Medical Center, Achterweg 5/P.O. Box 540 2103 SW Heemstede/2130 AM Hoofddorp, The Netherlands.
| | - Demetrios Velis
- Department of Clinical Neurophysiology, SEIN - Epilepsy Institute in The Netherlands, Meer en Bosch, The Netherlands; Department of CNP at the Free University Medical Center, Achterweg 5/P.O. Box 540 2103 SW Heemstede/2130 AM Hoofddorp, The Netherlands; Department of Neurosurgery at the Free University Medical Center, Achterweg 5/P.O. Box 540 2103 SW Heemstede/2130 AM Hoofddorp, The Netherlands.
| | - Elise Reus
- Department of Clinical Neurophysiology, SEIN - Epilepsy Institute in The Netherlands, Meer en Bosch, The Netherlands; Department of CNP at the Free University Medical Center, Achterweg 5/P.O. Box 540 2103 SW Heemstede/2130 AM Hoofddorp, The Netherlands; Department of Neurosurgery at the Free University Medical Center, Achterweg 5/P.O. Box 540 2103 SW Heemstede/2130 AM Hoofddorp, The Netherlands.
| | - Antonio Gil-Nagel
- Servicio de Neurologia, Hospital Ruber Internacional, Calle de la Masó, 38, 28034 Madrid, Spain.
| | | | - Eugen Trinka
- Department of Neurology, Paracelsus Medical University, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Strubergasse 21, 5020 Salzburg, Austria.
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, CHUV, Bâtiment Champ de l'Air Rue du Bugnon 21, 1011 Lausanne, Switzerland; Translational and Integrative Group in Epilepsy Research (TIGER) and Institute for Epilepsies (IDEE), Lyon's Neuroscience Center, INSERM U1028, CNRS 5292, UCBL, Centre Hospitalier Le Vinatier 95 Bd Pinel, 69500 Bron, Lyon, France.
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Cleary RA, Thompson PJ, Thom M, Foong J. Postictal psychosis in temporal lobe epilepsy: Risk factors and postsurgical outcome? Epilepsy Res 2013; 106:264-72. [DOI: 10.1016/j.eplepsyres.2013.03.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 03/19/2013] [Accepted: 03/25/2013] [Indexed: 11/16/2022]
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Adachi N, Kanemoto K, de Toffol B, Akanuma N, Oshima T, Mohan A, Sachdev P. Basic treatment principles for psychotic disorders in patients with epilepsy. Epilepsia 2013; 54 Suppl 1:19-33. [PMID: 23458463 DOI: 10.1111/epi.12102] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In patients with epilepsy, coexisting psychoses, either interictal (IIP) or postictal (PIP), are associated with serious disturbance in psychosocial function and well-being, and often require the care of a specialist. Unfortunately, evidence-based treatment systems for psychosis in patients with epilepsy have not yet been established. This article aims to propose concise and practical treatment procedures for IIP and PIP based on currently available data and international consensus statements, and primarily targeting nonpsychiatrist epileptologists who are often the first to be involved in the management of these complex patients. Accurate and early diagnosis of IIP and PIP and their staging in terms of acuity and severity form the essential first step in management. It is important to suspect the presence of psychosis whenever patients manifest unusual behavior. Knowledge of psychopathology and both individual and epilepsy-related vulnerabilities relevant to IIP and PIP facilitate early diagnosis. Treatment for IIP involves (1) obtaining consent to psychiatric treatment from the patient, whenever possible, (2) optimization of antiepileptic drugs, and (3) initiation of antipsychotic pharmacotherapy in line with symptom severity and severity of behavioral and functional disturbance. Basic psychosocial interventions will help reinforce adherence to treatment and should be made available. Due consideration must be given to patients' ability to provide informed consent to treatment in the short term, with the issue being revisited regularly over time. Given the often prolonged and recurrent nature of IIP, treatment frequently needs to be long-term. Treatment of PIP consists of two aspects, that is, acute protective measures and preventive procedures in repetitive episodes. Protective measures prioritize the management of risk in the early stages, and may involve sedation with or without the use of antipsychotic drugs, and the judicious application of local mental health legislation if appropriate. As for preventative procedures, optimizing seizure control by adjusting antiepileptic drugs or by surgical treatment is necessary.
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Hilger E, Zimprich F, Jung R, Pataraia E, Baumgartner C, Bonelli S. Postictal psychosis in temporal lobe epilepsy: a case-control study. Eur J Neurol 2013; 20:955-61. [DOI: 10.1111/ene.12125] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 01/30/2013] [Indexed: 11/26/2022]
Affiliation(s)
- E. Hilger
- Department of Neurology; Medical University of Vienna; Austria; Austria
| | - F. Zimprich
- Department of Neurology; Medical University of Vienna; Austria; Austria
| | - R. Jung
- Department of Neurology; Medical University of Vienna; Austria; Austria
| | - E. Pataraia
- Department of Neurology; Medical University of Vienna; Austria; Austria
| | - C. Baumgartner
- 2nd Neurological Department; General Hospital Hietzing with Neurological Center Rosenhuegel; Vienna; Austria
| | - S. Bonelli
- Department of Neurology; Medical University of Vienna; Austria; Austria
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21
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Abstract
Apart from the rather rare ictal psychotic events, such as non-convulsive status epilepticus, modern epileptic psychoses have been categorized into three main types; chronic and acute interictal psychoses (IIPs) and postictal psychosis (PIP). Together, they comprise 95% of psychoses in patients with epilepsy (PWE). Four major questions, that is, "Is psychosis in PWE a direct consequence of epilepsy or schizophrenia induced by epilepsy?", "Is psychosis in PWE homogeneous or heterogeneous?", "Does psychosis in PWE have symptomatological differences from schizophrenia and related disorders?", "Is psychosis in PWE uniquely associated with temporal lobe epilepsy (TLE)?" are tried to be answered in this review with relevant case presentations. In the final section, we propose a tentative classification of psychotic illness in PWE, with special attention to those who have undergone epilepsy surgery. Psychotic disorders in PWE are often overlooked, mistreated, and consequently lingering on needlessly. While early diagnosis is unanimously supported as a first step to avoid this delay, necessity of switching from antiepileptic drugs with supposedly adverse psychotopic effects. to others is more controversial. To elucidate the riddle of alternative psychosis, we need badly further reliable data.
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Affiliation(s)
- Kousuke Kanemoto
- Department of Neuropsychiatry, Aichi Medical University, Nagakute, Aichi, Japan
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22
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Sakakibara E, Nishida T, Sugishita K, Jinde S, Inoue Y, Kasai K. Acute psychosis during the postictal period in a patient with idiopathic generalized epilepsy: postictal psychosis or aggravation of schizophrenia? A case report and review of the literature. Epilepsy Behav 2012; 24:373-6. [PMID: 22652424 DOI: 10.1016/j.yebeh.2012.04.127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 04/10/2012] [Accepted: 04/21/2012] [Indexed: 11/30/2022]
Abstract
Postictal psychoses are common comorbid conditions of temporal lobe epilepsy and are reported to be characterized by affective changes. However, postictal psychoses are rare among patients with idiopathic generalized epilepsy, and the causal relationship between postictal psychoses and idiopathic generalized epilepsy is unknown. Here, we report the case of a man who had idiopathic generalized epilepsy and experienced 4 episodes of schizophrenia-like interictal psychosis before the age of 41 years. At the age of 56 years, he experienced a generalized tonic-clonic seizure for the first time in 15 years and developed psychotic symptoms on the next day. Notably, in addition to the schizophrenia-like symptoms, the patient experienced mania-like symptoms such as elated mood, grandiose delusions, agitation, and pressured speech during the last psychotic episode in the postictal period. It was suspected that postictal neuronal processes and a predisposition to endogenous psychosis both contributed to the psychopathology of this episode.
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Affiliation(s)
- Eisuke Sakakibara
- Department of Psychiatry, National Center of Neurology and Psychiatry, National Center Hospital, Kodaira, Tokyo, Japan.
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23
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Kuba R, Brázdil M, Rektor I. Postictal psychosis and its electrophysiological correlates in invasive EEG: a case report study and literature review. Epilepsy Behav 2012; 23:426-30. [PMID: 22436442 DOI: 10.1016/j.yebeh.2012.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 02/04/2012] [Accepted: 02/05/2012] [Indexed: 10/28/2022]
Abstract
We identified two patients with medically refractory temporal lobe epilepsy, from whom intracranial EEG recordings were obtained at the time of postictal psychosis. Both patients had mesial temporal epilepsy associated with hippocampal sclerosis. In both patients, the postictal psychosis was associated with a continual "epileptiform" EEG pattern that differed from their interictal and ictal EEG findings (rhythmical slow wave and "abortive" spike-slow wave complex activity in the right hippocampus and lateral temporal cortex in case 1 and a periodic pattern of triphasic waves in the contacts recording activity from the left anterior cingulate gyrus). Some cases of postictal psychosis might be caused by the transient impairment of several limbic system structures due to the "continual epileptiform discharge" in some brain regions. Case 2 is the first report of a patient with TLE in whom psychotic symptoms were associated with the epileptiform impairment of the anterior cingulate gyrus.
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Affiliation(s)
- Robert Kuba
- Brno Epilepsy Centre, First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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Walterfang M, Kornberg A, Adams S, Fietz M, Velakoulis D. Post-ictal psychosis in adolescent Niemann-Pick disease type C. J Inherit Metab Dis 2010; 33 Suppl 3:S63-5. [PMID: 20069374 DOI: 10.1007/s10545-009-9021-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 11/18/2009] [Accepted: 11/20/2009] [Indexed: 10/20/2022]
Abstract
We describe the presentation of an adolescent with juvenile-onset Niemann-Pick disease type C (NPC) who presented with post-ictal psychosis in the context of a developing seizure disorder. After demonstrating mild gait disturbance beginning at the age of 4 years, he was diagnosed with NPC at age 12 on the basis of 95% of cultured fibroblasts staining positive for filipin and a reduced fibroblast cholesterol esterification rate. He then developed a seizure disorder at age 15, where clusters of seizures produced typical psychotic symptoms, including hallucinations and delusions. His seizure disorder responded to valproate, which resulted in a settling of his psychotic symptoms. Whilst post-ictal psychosis is rarely reported prior to the age of 16, NPC in adolescents and adults is particularly psychotogenic and may increase the risk for post-ictal psychosis in the pediatric population.
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Affiliation(s)
- Mark Walterfang
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia.
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26
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Dobesberger J, Walser G, Unterberger I, Seppi K, Kuchukhidze G, Larch J, Bauer G, Bodner T, Falkenstetter T, Ortler M, Luef G, Trinka E. Video-EEG monitoring: Safety and adverse events in 507 consecutive patients. Epilepsia 2010; 52:443-52. [DOI: 10.1111/j.1528-1167.2010.02782.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Postictal behaviors and symptoms often require special assessment and treatment. We review risk factors for postictal delirium and psychosis and management of agitated and confused behaviors in patients after seizures. Medical and emergency staff require careful training to manage behaviors associated with postictal delirium and psychosis in order to protect patients while their confusion resolves. Treatment of postictal states requires recognition of underlying neurological and systemic disorders associated with seizures and delirium such as metabolic disorders and nonconvulsive seizures. There is incomplete information about the causes and optimal treatments for seizure-related psychosis, however, postictal behaviors can usually be managed safely.
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Affiliation(s)
- Gregory Krauss
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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28
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Ito M. Neuropsychiatric evaluations of postictal behavioral changes. Epilepsy Behav 2010; 19:134-7. [PMID: 20708439 DOI: 10.1016/j.yebeh.2010.06.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 06/17/2010] [Indexed: 11/18/2022]
Abstract
Postictal behavioral changes (PBCs), including psychosis, aggression, and mood change, are commonly observed in patients with epilepsy. Recognition and description of the clinical manifestations of PBCs would help in understanding and treating patients. Additionally, various quantified objective scales that are widely available in clinical psychiatry could be used to assess the clinical symptoms of PBCs. There are few reports in which objective rating scales have been used to assess neuropsychiatric symptoms in patients with epilepsy. However, there have been a small number of studies on interictal psychosis and depression in which either the Brief Psychiatric Rating Scale or the Hamilton Depression Scale was used. These inventories are likely to be useful for the assessment of PBCs. Other rating scales used for schizophrenia, depression, mania, and aggressive behavior are reviewed here. The author suggests that cross-sectional and longitudinal neuropsychiatric measurement combined with other modalities, including functional neuroimaging, could provide clues to the pathophysiology of PBCs.
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Affiliation(s)
- Masumi Ito
- Department of Neuropsychiatry, Tenshi Hospital, Sapporo, Japan.
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29
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Abstract
Postictal psychoses represent a considerable clinical challenge and are often unrecognized. In this review, the clinical features of the syndromes and the underlying biological foundations, as revealed through EEG and imaging studies, are discussed. It is concluded that although the syndrome can be well recognized, it is not acknowledged in standard diagnostic manuals, hence the relative neglect in the epilepsy literature.
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30
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Schulze-Bonhage A, van Elst LT. Postictal psychosis: Evidence for extrafocal functional precursors. Epilepsy Behav 2010; 18:308-12. [PMID: 20605532 DOI: 10.1016/j.yebeh.2010.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 02/24/2010] [Accepted: 02/24/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postictal psychosis is a particular entity with unclear relationship to preceding epileptic seizures. In particular, the role of ongoing interictal and ictal epileptic discharges in the epileptic focus, as opposed to widespread changes in cortical networks in its generation, has remained controversial. METHODS We describe two patients with temporal lobe epilepsy who developed a schizophreniform postictal psychosis after seizure clustering during or following invasive depth EEG monitoring. EEGs were analyzed for the presence of interictal and ictal discharges, and videos were analyzed for possible precursors of postictal psychosis, with particular focus on postictal neuropsychological impairments in preceding episodes. RESULTS The development of psychosis was related neither to ongoing subclinical ictal activity nor to suppression of interictal discharges in the epileptic focus. There was, however, increasing severity and duration of cognitive impairment following the seizures in the cluster preceding psychotic symptoms in that the patients progressively developed postictal aphasic symptoms and disorientation before becoming overtly psychotic. CONCLUSION The cases suggest that the buildup to schizophreniform postictal psychosis may not be related to epileptic discharges in the focus, but may develop as a consequence of ictal activity and postictal functional impairment of extended brain regions.
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31
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Abstract
Postical psychosis often complicates chronic epilepsy, especially in patients with seizure clusters that include tonic-clonic seizures, bilateral cerebral dysfunction (e.g., bilateral epileptiform activity or history of encephalitis), and a family history of psychiatric illness. Psychosis includes delusions, auditory and visual hallucinations, mood changes, and aggressive behavior. It typically emerges after a lucid interval of hours or days after the last seizure. This treatable disorder is associated with serious morbidity and mortality.
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Affiliation(s)
- Orrin Devinsky
- Departments of Neurology, Psychiatry, and Neurosurgery, NYU Epilepsy Center New York, NY, USA.
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32
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de Toffol B. [Postictal psychosis]. Rev Neurol (Paris) 2009; 165:769-73. [PMID: 19683323 DOI: 10.1016/j.neurol.2009.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 07/03/2009] [Accepted: 07/08/2009] [Indexed: 11/29/2022]
Abstract
In epilepsy patients, psychotic states are related to a group of psychotic disorders with a specific phenomenology in which potential pathophysiological mechanisms are believed to be closely related to the epileptic disorder itself. Postictal psychosis is a very specific syndrome in relation to seizure activity: a clear temporal relationship exists between the psychotic state of sudden onset and a precipitating bout of complex partial or generalized seizures, with a characteristic lucid interval which lasts from two to 120h. The psychotic state may be related to the withdrawal of anticonvulsants, often in connection with video-EEG monitoring. The phenomenology of the psychotic state is often pleomorphic, with abnormal mood, paranoid delusions and hallucinations, with some clouding of consciousness or no evidence of impaired consciousness. The outcome is characterized by a remission of the psychotic symptoms over several days (mean: 1 week), with or without neuroleptic treatment. The majority of the patients suffer from complex partial seizures with frequent psychic auras that secondarily become generalized. In the majority of cases, prepsychotic EEG abnormalities persist during the psychosis. Frequent bitemporal foci are recorded on the EEG and MRI abnormalities (including mesial temporal sclerosis) are seen in more than half of the cases. The results of clinical, morphologic and metabolic available studies will be briefly discussed.
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Affiliation(s)
- B de Toffol
- Clinique neurologique, CHU Bretonneau, Tours, France.
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33
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D'Alessio L, Giagante B, Papayannis C, Oddo S, Silva W, Solís P, Donnoli V, Kauffman M, Consalvo D, Zieher LM, Kochen S. Psychotic disorders in Argentine patients with refractory temporal lobe epilepsy: a case-control study. Epilepsy Behav 2009; 14:604-9. [PMID: 19236954 DOI: 10.1016/j.yebeh.2009.02.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 02/15/2009] [Accepted: 02/18/2009] [Indexed: 10/21/2022]
Abstract
The issue of psychotic disorders in epilepsy has given rise to great controversy among professionals; however, there are not many studies in this area and the physiopathological mechanisms remain unknown. The aim of this study was to describe the spectrum of psychotic disorders in an Argentine population with refractory temporal lobe epilepsy (RTLE) and to determine the risk factors associated with psychotic disorders. Clinical variables of the epileptic syndrome were compared among a selected population with RTLE with and without psychotic disorders (DSM-IV/Ictal Classification of psychoses). Logistic regression was performed. Sixty-three patients with psychotic disorders (Psychotic Group, PG) and 60 controls (Control Group, CG) were included. The most frequent psychotic disorders were brief psychotic episodes (35%) (DSM-IV) and interictal psychosis (50%) (Ictal Classification). Risk factors for psychotic disorders were bilateral hippocampal sclerosis, history of status epilepticus, and duration of epilepsy greater than 20 years.
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Falip M, Carreño M, Donaire A, Maestro I, Pintor L, Bargalló N, Boget T, Raspall A, Rumià J, Setoaín J. Postictal psychosis: A retrospective study in patients with refractory temporal lobe epilepsy. Seizure 2009; 18:145-9. [DOI: 10.1016/j.seizure.2008.08.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2008] [Revised: 06/18/2008] [Accepted: 08/15/2008] [Indexed: 11/28/2022] Open
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Angelopoulos E, Gatzonis S, Siatouni A, Angelakis E, Sakas DE. Remission of drug-resistant epileptic psychosis following left selective amygdalohippocampectomy. Epilepsy Behav 2009; 14:393-5. [PMID: 18706520 DOI: 10.1016/j.yebeh.2008.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 07/23/2008] [Accepted: 07/26/2008] [Indexed: 11/30/2022]
Abstract
We describe two female patients with drug-resistant mesial temporal lobe epilepsy and chronic drug-resistant psychosis. In both patients, MRI scans revealed left mesial temporal sclerosis. After clinical assessment, ictal video/EEG monitoring, and a neuropsychological evaluation including Wada testing, the patients underwent selective left amygdalohippocampectomy. Since the operation, the two patients have remained free of seizures for 17 and 15 months. During the same period, both patients have sustained a full remission of the psychosis.
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Affiliation(s)
- Elias Angelopoulos
- Department of Psychiatry, University of Athens Medical School, Eginition Hospital, Athens, Greece.
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36
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Abstract
BACKGROUND People suffering from epilepsy have an increased risk of suffering from psychotic symptoms. The psychotic syndromes associated with epilepsy have generally been classified as ictal, postictal and interictal psychosis. Anticonvulsant drugs have been reported to precipitate psychosis. Moreover, all antipsychotic drugs have the propensity to cause paroxysmal EEG abnormalities and induce seizures. OBJECTIVES To evaluate the benefits of interventions used to treat clinically significant psychotic symptoms occurring in people with epilepsy with regard to global improvement, changes in mental state, hospitalization, behavior, quality of life, effect on the frequency of seizures and interaction with antiepileptic drugs. SEARCH STRATEGY We searched the Trials Registers of the Cochrane Schizophrenia Group and the Cochrane Epilepsy Group (May 2008), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2008), MEDLINE (Ovid, 1950 to 14 May 2008), EMBASE (1980 to 2006), PsycINFO (1872 to 12 May 2008), CINAHL (1981 to 9 May 2008) and Biological Abstracts using the Cochrane Schizophrenia Group's phrase for randomized controlled trials and schizophrenia or psychotic disorders combined with the phrase [and {epilepsy* or seizure disorders* }].Two review authors (SF and AS) independently inspected the citations identified from the search. We identified potentially relevant abstracts and assessed full papers for inclusion and methodological quality. SELECTION CRITERIA All randomized controlled trials comparing drugs, behavior therapy, cognitive behavior therapy or other non-pharmacological interventions used to relieve psychotic symptoms in people with epilepsy. DATA COLLECTION AND ANALYSIS We planned to extract and analyze the data from all relevant studies using standardized methods. As only one study met the inclusion criteria, no meta-analysis was attempted. MAIN RESULTS After independently assessing the abstracts and titles of 492 articles, we selected five relevant abstracts. Ultimately we found only one study meeting the inclusion criteria, which was available only as an abstract. This study compared the use of olanzapine (10 mg/day) with haloperidol (12 mg/day) in 16 patients suffering from schizophrenia-like psychosis of epilepsy (SLPE). Thirteen patients completed the study. Significant improvement was associated with use of olanzapine. We did not identify any study on psychosocial interventions in patients suffering from epilepsy and psychosis. AUTHORS' CONCLUSIONS Only one randomized controlled trial was found which lacked the power to test the efficacy of antipsychotics in those suffering from psychosis concomitant with epilepsy.Limited evidence from this small RCT suggests an improvement in psychotic symptoms, but not other outcome measures, with the use of an antipsychotic. The effects on seizure control are not well studied. Further trials are required to inform practice.
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Affiliation(s)
- Saeed Farooq
- Postgraduate Medical Institute, Kyber Medical University, Peshawar, Pakistan.
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37
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[Postictal psychosis syndrome: a clinical entity to be recognized]. Rev Neurol (Paris) 2008; 165:155-63. [PMID: 18817939 DOI: 10.1016/j.neurol.2008.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Revised: 06/03/2008] [Accepted: 07/02/2008] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Post-ictal psychosis syndrome (PIP) belongs to the group of epileptic psychoses which, according to the most commonly used classification, is to be distinguished from ictal psychoses, on one hand, and from inter-ictal psychoses, on the other. OBJECTIVES The present paper aims to review recent data concerning the clinical, therapeutic and pathophysiological aspects of PIP. METHODS We report four cases of PPI, which involved four patients hospitalized at the Salpêtrière hospital between 2001 and 2005, and discuss these cases in light of the relevant literature. RESULTS The PIP fit generally occurs in patients suffering from intractable temporal lobe epilepsy which started several years before. The psychiatric disorders suddenly take hold after a series of complex partial seizures with frequent secondarily generalized tonic clonic seizures. During the episode, EEG recordings do not show any epileptic activity. Psychiatric symptoms consist of persecutory delusive ideas, verbal and visual hallucinations, agitation, and aggressiveness. Mood disorders are variable from one patient to another and exhibit intraindividual fluctuation. In most patients given antipsychotic drugs, the short-term outcome of PIP is favorable . In the long-term, even if recurrence is the main long-term risk, progression to severe mood disorders or to poor prognosis inter-ictal psychosis is possible. Accordingly, the clinician must be aware of this syndrome in order to correctly diagnose PIP since effective treatment with antipsychotic drugs is available. CONCLUSION The short-term prognosis of PPI is usually favorable but this syndrome can potentially develop in the long-term to more severe psychiatric disorders. It is, therefore, important to recognize PIP syndromes which respond more readily to pharmacological treatments than other types of psychoses.
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Prolonged preictal psychosis in refractory seizures: a report of three cases. Epilepsy Behav 2008; 13:252-5. [PMID: 18314397 DOI: 10.1016/j.yebeh.2007.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Revised: 10/22/2007] [Accepted: 11/19/2007] [Indexed: 11/23/2022]
Abstract
Seizures and psychosis coexist in a large number of patients with epilepsy, and a significant amount of research on their relationship has been published. There are several reports and reviews on postictal and interictal psychosis in patients with epilepsy. We describe three patients with refractory temporal lobe epilepsy, each of whom presented with a history of episodic psychosis that preceded almost all habitual seizures and, thus, served as a useful warning symptom. All three patients had intractable left complex partial seizures; two had right mesial temporal sclerosis, and the third had a gliotic area in the right frontotemporal region on MRI. This is the first report of psychosis preceding seizures. The literature on seizure anticipation, as well as on the complex relationship between seizures and psychosis, is also reviewed.
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Alper K, Kuzniecky R, Carlson C, Barr WB, Vorkas CK, Patel JG, Carrelli AL, Starner K, Flom PL, Devinsky O. Postictal psychosis in partial epilepsy: a case-control study. Ann Neurol 2008; 63:602-10. [PMID: 18481288 DOI: 10.1002/ana.21341] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Divergent findings among prior studies on correlates of risk for postictal psychosis (PIP) suggest the value of a controlled study involving a relatively large number of patients. METHODS The study population consisted of a consecutive series of 59 patients with partial epilepsy and a history of PIP, and 94 control patients with partial epilepsy and no history of PIP evaluated as inpatients with video-electroencephalography. The groups did not differ significantly regarding demographic features. Exact tests yielded a subset of variables and a tentative interpretation that were evaluated further utilizing principal components analysis and logistic regression. RESULTS PIP was associated with extratemporal versus temporal (p = 0.036) or undetermined (p = 0.001) localization of seizure onset, bilateral interictal epileptiform activity (p = 0.017), secondary generalization (p = 0.049), and history of encephalitis (p = 0.018). Interictal slow activity was more frequently absent in control patients (p = 0.045). PIP was associated with family histories of psychiatric disorders (p = 0.007) and epilepsy (p = 0.042), which themselves were significantly intercorrelated (r = 0.225; p = 0.006). Age of onset or duration of epilepsy and lateralized electroencephalographic or magnetic resonance imaging asymmetries did not differ significantly between control and PIP groups. The analysis indicated four underlying domains of risk for PIP: ambiguous/extratemporal localization, family neuropsychiatric history, abnormal interictal electroencephalographic activity, and encephalitis. Each unit increase on a simple additive scale composed of 9 dichotomous independent variables multiplied the odds ratio for PIP by 1.71 (95% confidence interval, 1.36-2.15; p < 0.0001). INTERPRETATION PIP in partial epilepsy is associated with relatively broadly and bilaterally distributed epileptogenic networks, genetic determinants of psychiatric disorders and seizures, and encephalitis.
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Affiliation(s)
- Kenneth Alper
- Department of Neurology, Comprehensive Epilepsy Center, New York, NY 10016, USA.
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Kanner AM, Ostrovskaya A. Long-term significance of postictal psychotic episodes I. Are they predictive of bilateral ictal foci? Epilepsy Behav 2008; 12:150-3. [PMID: 18086458 DOI: 10.1016/j.yebeh.2007.09.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2007] [Revised: 09/05/2007] [Accepted: 09/05/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to determine the degree to which postictal psychotic episodes (PIPE) are predictive of bilateral independent ictal foci. METHODS This was a retrospective study of 18 consecutive adults with a partial seizure disorder and PIPE (study group) and 36 patients with a partial seizure disorder but without PIPE (control group). The two groups were compared with respect to the number and location of ictal foci identified with video/EEG monitoring, seizure type, etiology, age at seizure onset, duration of seizure disorder, MRI abnormalities, and psychiatric history prior to the index video/EEG monitoring (other than PIPE). Statistical analyses consisted of logistic regression models, one to identify the variables predictive of bilateral ictal foci and the other to identify the variables predictive of PIPE. RESULTS The occurrence of PIPE (P<0.0001) and cryptogenic partial epilepsy (P=0.004) was predictive of bilateral independent ictal foci in univariate analyses. In multivariate analyses, cryptogenic partial epilepsy was the only significant variable (P=0.03). Conversely, bilateral independent ictal foci on video/EEG monitoring (P<0.0001) and having secondarily generalized tonic-clonic seizures (P=0.035) were independent predictors of the development of PIPE in univariate and multivariate analyses. Surgery was performed in 20 controls and 3 patients with PIPE; 17 controls and 2 patients with PIPE became seizure-free. CONCLUSIONS The presence of PIPE appears to be a predictor of bilateral ictal foci.
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Affiliation(s)
- Andres M Kanner
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA.
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Chiesa V, Gardella E, Tassi L, Canger R, Lo Russo G, Piazzini A, Turner K, Canevini MP. Age-related gender differences in reporting ictal fear: analysis of case histories and review of the literature. Epilepsia 2007; 48:2361-4. [PMID: 17666073 DOI: 10.1111/j.1528-1167.2007.01227.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To determine if there are age or gender-related differences in reporting fear as a symptom of epileptic seizure, all clinical charts of patients evaluated at the "C. Munari - Epilepsy Surgery Center" of Milan from 1990 to June 2005 were analyzed, looking for patients with ictal fear. Among the 2,530 clinical charts examined (1,330 male and 1,200 female), 265 patients were found with ictal fear (100 men, 165 women). The gender difference in reporting ictal fear was not so marked in the pediatric age group (98 girls, 74 boys), whereas in adult patients the difference was significant (158 women, 83 men). Interestingly, more men than women (14:3) had ictal fear during childhood that disappeared during adulthood. The literature review confirmed that ictal fear is significantly more common in women, though there is no gender difference in the pediatric age group.
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Affiliation(s)
- Valentina Chiesa
- Regional Epilepsy Centre, San Paolo Hospital, University of Milan, Italy.
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Abstract
A comparison of the clinical and pathophysiological features of postictal psychosis and brief interictal or alternating psychosis was undertaken to examine if the underlying mechanisms are distinct in these 2 conditions. A selective review of the published literature in English on epilepsy and brief psychosis was carried out. The literature indicates that even though brief postictal and alternating psychoses are considered to be separate syndromes, they have a number of similarities. It can be argued that the underlying pathomechanisms are common, with the brain's inhibitory processes in response to seizures playing a key role in the development of the psychosis. These homeostatic mechanisms manifest as electrophysiological, cerebral blood flow, and neurotransmitter and receptor changes. Both syndromes are likely to be associated with prolonged inhibition in limbic circuits, with further seizures modifying the psychosis depending upon whether it is associated with disinhibition or hypersynchrony involving enhanced inhibition. The neurotransmitter with a key role is GABA, although ionic currents, catecholamines, opiates, adenosine, glutamate, and nitric oxide play a role. Brief postictal and alternating psychoses provide an opportunity to understand the complex relationships between epilepsy and schizophrenia-like brief psychotic episodes, and this understanding can assist in their management.
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Affiliation(s)
- Perminder S Sachdev
- Neuropsychiatric Institute, The Prince of Wales Hospital, Barker Street, Randwick NSW 2031, Australia.
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Ito M, Okazaki M, Takahashi S, Muramatsu R, Kato M, Onuma T. Subacute postictal aggression in patients with epilepsy. Epilepsy Behav 2007; 10:611-4. [PMID: 17418643 DOI: 10.1016/j.yebeh.2007.02.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Revised: 02/20/2007] [Accepted: 02/22/2007] [Indexed: 11/26/2022]
Abstract
Three men with epilepsy (age range, 38-62) who exhibited brief episodes of violent behavior during the postictal period are described. Disease duration ranged from 27 to 44 years. Patients had both complex partial seizures and secondarily generalized tonic-clonic seizures, which were refractory to antiepileptic drugs. Postictal aggression occurred shortly after a seizure and lasted 5-30 minutes. The patients displayed physically and verbally aggressive behavior toward others, but regained consciousness promptly and showed regret afterward. Interictal EEGs revealed temporal spikes, SPECT showed hypoperfusion in the temporal and frontal areas in two patients, and neuropsychological examination revealed poor frontal lobe function in two patients. Characteristics of our cases are consistent with subacute postictal aggression (SPA) reported previously. Epilepsy of prolonged duration and brain dysfunction involving a broad area including the temporal and frontal lobes may be associated with the occurrence of subacute postictal aggression.
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Affiliation(s)
- Masumi Ito
- Department of Psychiatry, National Center of Neurology and Psychiatry, Musashi Hospital, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8551, Japan.
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Adachi N, Ito M, Kanemoto K, Akanuma N, Okazaki M, Ishida S, Sekimoto M, Kato M, Kawasaki J, Tadokoro Y, Oshima T, Onuma T. Duration of postictal psychotic episodes. Epilepsia 2007; 48:1531-7. [PMID: 17386048 DOI: 10.1111/j.1528-1167.2007.01058.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To clarify duration of postictal psychosis (PIP) episodes and identify factors that influence its duration. METHODS Fifty-eight patients with epilepsy exhibited 151 PIP episodes during a mean follow-up period of 12.8 years. Distribution of the duration of these episodes was determined, and factors potentially affecting were analyzed. Factors analyzed included PIP-related variables (i.e., antecedent seizures and the lucid interval) and patient characteristics (i.e., type of epilepsy, lateralization of EEG abnormalities, and intellectual functioning). RESULTS The mean duration of the 58 first PIP episodes was 10.5 days, and that of all 151 PIP episodes (including multiple episodes) was 9.2 days. Approximately 95% of the PIP episodes resolved within 1 month. Most PIP-related variables, except for antipsychotic drugs administered, were not associated with duration of the episodes. Several patient characteristics, i.e., history of interictal psychosis, family history of psychosis, and intellectual functioning, were associated with duration of the PIP episodes. CONCLUSIONS This study showed that most PIP episodes last less than 1 month. PIP episodes appear to be prolonged when individuals have an underlying vulnerability to psychosis. Clinical phenomena that can trigger PIP may not determine the course of the PIP episode.
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Affiliation(s)
- Naoto Adachi
- Adachi Mental Clinic, Kitano 7-5-12, Kiyota, Sapporo 004-0867, Japan.
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Nishida T, Kudo T, Inoue Y, Nakamura F, Yoshimura M, Matsuda K, Yagi K, Fujiwara T. Postictal Mania versus Postictal Psychosis: Differences in Clinical Features, Epileptogenic Zone, and Brain Functional Changes during Postictal Period. Epilepsia 2006; 47:2104-14. [PMID: 17201710 DOI: 10.1111/j.1528-1167.2006.00893.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE To clarify the differences between postictal mania (PIM) and postictal psychosis (PIP). METHODS Five patients with PIM were compared to 17 patients with PIP, with respect to clinical, epileptological, electrophysiological, and neuroimaging features. PIM was distinguished from PIP by the symptoms observed in the postictal period based on the ICD-10 criteria. RESULTS Postictal manic episodes lasted for a longer period than postictal psychotic episodes. Patients with PIM had more recurrent postictal episodes than patients with PIP. The age at onset of epilepsy in patients with PIM was older than that in patients with PIP. PIM was associated with frontal lobe and temporal lobe epilepsies, whereas PIP was associated with temporal lobe epilepsy. The estimated epileptogenic zone was on the language dominant side in PIM, whereas there was no predominant hemispheric laterality in PIP. Electroencephalography (EEG) performed during the early period of postictal manic and psychotic episodes showed decreased frequency of interictal epileptiform discharges in both PIM and PIP. Single-photon emission computed tomography (SPECT) during postictal manic and psychotic episodes showed increased perfusion in the temporal and/or frontal lobes in both PIM and PIP. Three patients with PIM showed increased perfusion during postictal episodes on bilateral or the language nondominant side, which were contralateral to the estimated epileptogenic zone, whereas three patients with PIP showed increased perfusion on the areas, which were ipsilateral to the estimated epileptogenic zone. CONCLUSIONS PIM has a distinct position among the mental disorders observed in the postictal period.
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Affiliation(s)
- Takuji Nishida
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan.
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Rothenhäusler HB. [Clinical features, diagnosis, and treatment of dysphoric states and psychoses associated with epilepsy]. DER NERVENARZT 2006; 77:1381-91; quiz 1392. [PMID: 17061130 DOI: 10.1007/s00115-006-2186-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Although dysphoric states and psychoses represent clinically relevant psychiatric complications in patients with epilepsy, their symptomatologies are complex and therefore frequently underrecognized and undertreated in daily psychiatric routine. Detecting dysphoric states and psychoses secondary to the psychotropic effects of various antiepileptic drugs is often challenging, even for the most experienced psychiatrists. This article gives an overview of epidemiology, clinical features, diagnosis, and therapy of interictal, peri-ictal, and alternative dysphoric states and psychoses in patients with epilepsy. Further, potential drug interactions between antiepileptic and psychiatric medications are discussed.
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Affiliation(s)
- H-B Rothenhäusler
- Universitätsklinik für Psychiatrie der Medizinischen Universität Graz, Auenbruggerplatz 31, 8036 Graz.
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Pompili M, Girardi P, Tatarelli G, Angeletti G, Tatarelli R. Suicide after surgical treatment in patients with epilepsy: a meta-analytic investigation. Psychol Rep 2006; 98:323-38. [PMID: 16796084 DOI: 10.2466/pr0.98.2.323-338] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Suicide is a major issue in surgically treated epileptic patients. A meta-analysis was performed comparing suicides in a sample of such patients and in the general population. The Index Medicus and the World Health Statistics Annual were searched to ascertain the suicide rates in the age groups indicated in the studies of epileptic patients for specific years and country. 11 studies were selected, comprising 2,425 patients, 24 of whom committed suicide. Data obtained for each study were processed together to calculate the mean number of suicides per 100,000 individuals with surgically treated epilepsy for each year. This meta-analysis shows that suicide in patients with epilepsy after surgical treatment is more frequent than in the general population. Results are discussed with particular attention to possible causative factors.
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Affiliation(s)
- Maurizio Pompili
- McLean Hospital, Harvard Medical School, Belmont, Massachusetts, USA.
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Morrow EM, Lafayette JM, Bromfield EB, Fricchione G. Postictal psychosis: presymptomatic risk factors and the need for further investigation of genetics and pharmacotherapy. Ann Gen Psychiatry 2006; 5:9. [PMID: 16859554 PMCID: PMC1555577 DOI: 10.1186/1744-859x-5-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2005] [Accepted: 07/21/2006] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Postictal psychosis (PIP), an episode of psychosis occurring after a cluster of seizures, is common and may be associated with profound morbidity, including chronic psychosis. Symptoms are often pleomorphic, involving a range of psychotic symptoms, including hallucinations and disorders of thought. PIP is treatable and may be averted if presymptomatic risk factors are considered in susceptible patients and treatment is initiated. CASE PRESENTATION In this report, we present an illustrative case of PIP. The patient, Mr. R, presented to our emergency room with delusions and disordered thought process following a cluster of seizures. He recovered after admission, sedation and treatment with antipsychotic medication. DISCUSSION A list of presymptomatic risk factors is established based on review of current literature. Identification of such risk factors may potentially help with prophylactic treatment; however, little empirical research exists in this area and treatment guidelines are thus far largely based on expert opinion. Further, while the neurobiology of schizophrenia is advancing at a rapid pace, largely due to advances in genetics, the pathophysiology of PIP remains largely unknown. Considering the progress in schizophrenia research in the context of the clinical features of PIP and existing studies, potential neurobiological mechanisms for PIP are herein proposed, and further genetic analyses, which may help identify those susceptible, are warranted. CONCLUSION While PIP is an important problem that may present first to general hospital psychiatrists, as in the case presented, this topic is under-represented in the medical psychiatry literature. As discussed in this article, further research is needed to develop presymptomatic screens and treatment pathways to help prevent morbidity.
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Affiliation(s)
- Eric M Morrow
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Edward B Bromfield
- Division of Epilepsy and EEG, Department of Neurology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Gregory Fricchione
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
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La Vega-Talbot M, Duchowny M, Jayakar P. Orbitofrontal seizures presenting with ictal visual hallucinations and interictal psychosis. Pediatr Neurol 2006; 35:78-81. [PMID: 16814093 DOI: 10.1016/j.pediatrneurol.2005.12.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2005] [Revised: 11/17/2005] [Accepted: 12/28/2005] [Indexed: 11/25/2022]
Abstract
Hallucinations are commonly believed to reflect temporal lobe dysfunction. This report presents the clinical, electroencephalographic, and neuroimaging findings in an 8-year-old male who experienced the acute onset of ictal auditory and visual hallucinations associated with epileptic activation of the right orbitofrontal region. Right frontal lobe surgery resulted in seizure freedom and disappearance of his psychotic symptoms. Histologic tissue examination revealed non-balloon cell Taylor type cortical dysplasia.
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Affiliation(s)
- Maite La Vega-Talbot
- Department of Neurology and Comprehensive Epilepsy Program, Miami Children's Hospital, Miami, Florida 33155, USA
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50
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Joshi CN, Booth FA, Sigurdson ES, Bolton JM, Shah NS. Postictal psychosis in a child. Pediatr Neurol 2006; 34:388-91. [PMID: 16648000 DOI: 10.1016/j.pediatrneurol.2005.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Revised: 09/01/2005] [Accepted: 10/10/2005] [Indexed: 11/28/2022]
Abstract
Postictal psychosis is a state of psychosis following repeated or prolonged complex partial seizures with or without secondary generalization and is well described in adult epilepsy literature. It is sparsely reported in the pediatric literature. This report describes a 12-year-old male presenting with status epilepticus who developed psychotic symptoms. Diagnosis of postictal psychosis was made after correlating clinical symptoms with video-electroencephalographic monitoring. The clinical course of this illness is profiled, and the literature reviewed.
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Affiliation(s)
- Charuta N Joshi
- Division of Pediatric Neurology, Children's Hospital, Winnipeg, Manitoba, Canada.
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